By Josh Fischman

Evita's Cancer

The silence surrounding cervical cancer a generation ago is giving way to an era of increased communication—and optimism

By Josh Fischman

Sometimes, however, it doesn’t. HPV can invade skin stem cells—cells that continuously divide to replenish the skin—and this can cause a persistent infection. Even then it doesn’t mean cancer. But after about one to three years, says Dartmouth’s Harper, it can produce a low-grade precancerous clump of abnormal-looking cells. This can hang around for about five years, becoming a high-grade lesion. It’s still not cancer, though. That change can take approximately another five years, she says. All in all, it can take 13 years or so, on average, from the time of first infection to when cancer appears. That’s why, although peak HPV infection occurs during the late teens and early 20s, actual cancer is most often diagnosed in women, like Perón and Anderson, who are in their 30s or older.

There are many, many HPV types, but about a dozen account for more than 95 percent of cervical cancers. Two, in fact, are responsible for about 70 percent: types 16 and 18. And these two are targets of the latest strategies aimed at cervical cancer: HPV vaccines.

Heather Bentley, 25, of Ludlow, Vt., has been helping to test one vaccine approved in June by the Food and Drug Administration (FDA), called Gardasil. She learned about the virus-cancer connection in college, at the University of Connecticut. “It’s not really a big deal to talk about it. So I was actually really eager to help in the vaccine study.”

Earlier studies of the Gardasil vaccine have shown that it protects against HPV types 16 and 18 (as well as two other types known to cause genital warts) 100 percent of the time. That’s the efficacy behind its approval, and behind a federal recommendation, also made in June, that the three-shot series be administered routinely to 11- and 12-year-old girls—starting before they reach the ages when most get infected. The study in which Bentley is participating may reveal how long this protection will last. Data so far suggest up to three years. Results of studies testing a similar vaccine, Cervarix, hint that its protection could last four and a half years. (Cervarix has yet to be approved by the FDA.)

Gardasil still has to pass a price test. At $360 for the series of shots, it’s not cheap. That could make the shots inaccessible to poorer people in the U.S.—and the developing world—and that’s especially bad because lower-income groups have higher cervical cancer rates. Gardasil’s manufacturer, Merck, has said little about the high price, except that it will offer some kind of financial assistance program.

Bentley, while not defending Merck’s price scheme, thinks getting the vaccine is definitely worthwhile for those who have access to it. “A couple of shots instead of getting chemo: I’d take that option any day.”